Objective      To investigate the survival benefit and failure patterns of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) in elderly patients with advanced non-small cell lung cancer (NSCLC).       Methods      A total of 71 NSCLC patients with age ≥65 with acquired resistance to gefitinib or erlotinib in our hospital during June 2002 to August 2011 were enrolled in this study. EGFR gene mutation in tumor tissue was tested by direct sequencing. Survival benefit and failure sites were analyzed.       Results      Median progression-free survival (mPFS）and median overall survival (mOS）in the cohort were 10.0 months and 18.0 months respectively. mOSs in patients with EGFR activating mutations

wild-type or unknown status were 18.0

21.6 and 14.3 months

respectively (P=0.200). EGFR-TKIs in the first-line setting or other settings could produce comparable mOSs (18.0 vs 17.8 months

P=0.631). Failure included 3 patterns: 26.8% with pre-existing lesions progression

42.2% with occurrence of new lesions

and 31.0% with both. Failure patterns were not correlated with EGFR mutational status (r=-0.05

P=0.648). Patients of 25.4%were with extracranial progression

and 8.5% with intracranial progression. Only cranial failure was found in 11.1% of patients with baseline brain metastasis.       Conclusion      EGFR-TKIs produced rational survival benefit in Chinese elderly NSCLC. New lesions tend to occur on treatment failure

and progressive lesions limited in brain are seldom observed.